Random thoughts from a few cantankerous American physicians. All contributors are board certified. Various specialties are represented here. I do not know where this will lead but hope it will at least be an enjoyable read. All of the names mentioned in this blog are pseudonyms, the ages have been changed, and in half the cases the gender as well. All photographs are published with patient consent or are digitally altered to preserve anonymity. Trust us, we're doctors.

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Thursday, May 17, 2007

If you come in to my ED after placing a shotgun over your heart and pulling the trigger AND I take the ultrasound probe (pictured here on a very nice sonosite machine) to look for heart activity AND, after taking off the bandage that covers the wound, the ultrasound probe DISAPPEARS into your right and left ventricles, then you are DEAD. No, AngelFlight crew, there were never any pulses even with CPR- you are liars or fools. I hereby dub this the "vanishing probe" sign of death and it should be recognized with other sure indicators of death like rigor-mortis, decapitation, fixed and dilated pupils with asystole in three leads, and vaporization in an atomic blast.

In absence of an ultrasound probe, could you also determine the presence of a "snidely sign" using your fist while performing CPR? I figure many smaller community ED's without ultrasound should have an alternate method to make this important finding.

By the way, I jealously envy you your "modern" gadgets and technology. Our ER has NOTHING like that. Here in Podunk we're in the dark ages in everything else, too, (hence, the fact that I had to lead the EMT's out of ranch country when my own patient died at home two weeks ago and the poor EMTs had gotten lost on the way there and didn't want to get lost going back---I always have to give the ambulance guys directions...)

(I'm having a hard time getting over that death---he was a favorite patient...)

And speaking of being in the "cuntry", two days ago on my way to work, I saw a man washing his horse in the car wash. (But it was a white horse, after all, so I guess I can understand...)

All of my medical training comes from episodes of ER or Grey's Anatomy...which qualifies me to identify drama more than trauma, but I'm guessing even I could have diagnosed this one. Hmmm, huge whole where the heart used to be. If I recall correctly, that's one of those important organs.

very perceptive, mark. there was an element of this at the scene. what is still not clear is why the ground crew called the helicopter to meet them at the nearest landing area or why the crew flew. the guy was dead and helicopters crash. it was a foolish thing.